Contraception — A Basic Health Necessity

Affordable Access Needed for All Women

May 8, 2007

San Diego, CA -- Ob-gyns today addressed the critical need for increased insurance coverage of contraceptive services for women in the US at a news conference during the 55th Annual Clinical Meeting of The American College of Obstetricians and Gynecologists (ACOG). Speakers discussed the barriers that impede many women from securing contraception and the crippling effect that unintended pregnancy can have on women and society.

"Whenever we seem to make progress in providing contraceptive coverage to all women, we experience a significant setback like the March 2007 8th Circuit Court of Appeals' ruling that employers do not have to pay for contraception for their employees," said Vivian M. Dickerson, MD, past president of ACOG. "This type of judgment sends the message that women's health care needs are not taken seriously. When will the US stop treating its women as second-class citizens?" she asked.

"More options than ever exist for safe, effective family planning, yet too many women still face too many hurdles in accessing them. Most of the 16.8 million women in need of publicly funded contraceptive services do not have access to proper care—even women with health insurance have a hard time paying for contraception," Dr. Dickerson said.

Two-thirds of women rely on private insurers for their health coverage, yet a majority of these insurers do not cover contraception. Women already pay 68% more than men do for out-of-pocket medical costs, due in great part to their reproductive health coverage. States should be working to reduce these gaps, not making it more difficult and more expensive for women to get the health care they need.

The typical US woman will need birth control for more than three decades of her life, and not only to avoid pregnancy. For years, doctors have prescribed hormonal contraceptives to alleviate heavy bleeding, irregular periods, and acne and to protect against a number of other health problems that affect women, such as ovarian cysts, bone loss, benign breast disease, the symptoms of polycystic ovary syndrome, and anemia. According to ACOG, contraception is basic, preventive health care and should be readily available and treated the same as prophylactic therapies for other medical conditions.

"Without access to contraception, women are made to play Russian roulette with their fertility," said Rebekah E. Gee, MD, an ob-gyn at Philadelphia Veteran's Affairs Medical Center and Robert Wood Johnson clinical scholar at the University of Pennsylvania. "A sexually active woman who has unprotected sex for five years will experience an average of 4.25 unintended pregnancies. Restricting a woman's family planning options essentially forces her to accept those unacceptable odds," she added.

Nearly half of all US women will experience an unintended pregnancy at some point in their lives—31% of those pregnancies will result in an unintended birth, and 42% will end in abortion. "Unintended pregnancy can lead to a slew of negative maternal and infant outcomes. Women who were not planning a pregnancy are less likely to have a prenatal visit during the critical first trimester," Dr. Gee noted. "These women are more apt to continue engaging in behaviors that can be harmful to a pregnancy, such as drinking, smoking, using drugs, and consuming an unbalanced diet that deprives the fetus of vital nutrients. They also tend to have less healthy pregnancies and lower-birth-weight babies."

Unintended pregnancy is not only a burden on women. It is also costly to US taxpayers, employers, and insurers. Studies have shown that providing comprehensive contraceptive coverage to women would represent a negligible cost to employers and could save up to $19 billion annually in expenses directly related to unintended pregnancy.

"Over the past 15 years, we have made strides in gaining comprehensive contraceptive coverage for many women in the US. Action by some states has helped correct inequities in access, and more insurers are covering a wider variety of contraceptive methods than ever before," said Kathryn Moore, ACOG director of state legislative and regulatory affairs. "However, there is much more to be done," she noted.

Twenty-two states still do not require insurers to cover contraception. These same insurers voluntarily cover drugs like Viagra, insinuating that male sexual dysfunction is a more pressing public health concern than unintended or unwanted pregnancy. "The recent Circuit Court decision is particularly disappointing because it overruled anti-discriminatory guidance from earlier cases on contraceptive coverage," Moore continued. The 8th Circuit Court of Appeals is the first federal court to rule on this issue and has jurisdiction in Arkansas, Iowa, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota. "ACOG will push to overturn this biased ruling, continue to challenge prohibitive state insurance policies, and support states that have adopted favorable access laws," she said.

"We can't let the recent hard-earned victory in obtaining over-the-counter status for emergency contraception lull us into complacency. Ob-gyns must stay vigilant and advocate for affordable access to basic health necessities like contraception," Dickerson noted. "The ability to control fertility is a basic right that all women are entitled to. Women's reproductive health is at stake."

The American College of Obstetricians and Gynecologists is the national medical organization representing over 51,000 members who provide health care for women.